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APPLICATION FOR MEMBERSHIP

Applicant's Surname    
First Name    

Preferred First Name Date of Birth
(for office use only)
Phone Home Phone Work
Phone Mobile    

Employer
Current Postition
(include date commenced)

Work Postal Address
Home Postal Address
Send postal mail to:

Preferred E-mail Alternate E-mail

Academic Qualifications
(include Institution and year)
Recent work
(include dates)

Are you now, or have you ever been, a paid member of IPENZ?          If Yes, please provide IPENZ number:

Please list membership of any other professional groups e.g. AITPM, ITE

Please tick any Transportation Group subgroup you wish to receive communication from: (NB Subgroups do not charge extra fees for membership.)
Signals NZ User Group (SNUG)
NZ Modelling User Group (NZMUGS)
Roundabout newsletter*: email or hard copy.

*The Roundabout is the quarterly Transportation Group Newsletter. You can choose to receive this by email or in hard copy format.


Please select your Employment Status    
Employment Status Annual Fee Please select one
1. Employed $55.00 ($63.25 incl. GST)
2. Unemployed $15.00 ($17.25 incl. GST)
3. Retired $15.00 ($17.25 incl. GST)
4. Full time student $ 0.00

You will be invoiced separately by IPENZ.

Send no payment now

Notes: There is an additional IPENZ administration service fee of $45 ($51.75 incl. GST) charged to members that do not already pay it as part of their IPENZ membership, except full time students who are not charged. Currently all new members of the Transportation Group receive a free copy of the publication "A Wheel on Each Corner" by Malcolm Douglass.

PRIVACY: Please advise if you are unwilling to have your name, position, organisation and Transportation Group branch listed on the members' only part of the Transportation Group website by ticking this box

Reference:

The Transportation Group is a Technical Interest Group of IPENZ. Please nominate an existing Transportation Group member to act as a referee for your membership application to the Transportation Group.

The Group welcomes membership applications from all those interested.

If you cannot easily provide a referee then simply send the form in with this section left blank and the National Committee will provide a suitable referee for you.

Referee's Name Referee's IPENZ Number
Referee's Phone (Home/Work) Referee's Phone (Mobile)

Print a PDF version of this application to post instead.